Guidance for Implementing the Massachusetts School Nutrition Standards for Competitive Foods and Beverages
Developed by: Massachusetts Department of Public Health Massachusetts Department of Elementary and Secondary Education John C. Stalker Institute of Food and Nutrition at Framingham State University Harvard School of Public Health Boston Public Health Commission December 2011
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Table of Contents
Acknowledgements Introduction Definitions Massachusetts School Nutrition Regulations At-a-Glance Foods and Beverages That Meet Massachusetts School Nutrition Standards Procurement and Contracting Additional School Nutrition Food and Beverage Regulations School Wellness Advisory Committees Resources for Implementation Alternatives for School Fund-Raising Activities Healthy Celebrations Recommendations to Create and Support a Healthy School Environment Financial Implications Other Resources Q & As Making the Case for Healthier Schools with Parents
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Acknowledgements
The Massachusetts Department of Public Health and the Massachusetts Department of Elementary and Secondary Education wish to acknowledge the valuable commitment of Massachusetts educators and public health practitioners working in collaboration to develop these comprehensive and evidence-based standards for competitive foods and beverages provided in public schools: Massachusetts Department of Public Health: Cynthia Bayerl, Diana Hoek, Howard Saxner, Alison Mehlman, Christina Nordstrom, Anne Sheetz, Lauren Smith and Laura York; Interns: Marcy Ruda (Simmons College); Kelly Coughlin (Boston University), Alexandra Pitkin (University of Connecticut) and Bobbie Condrat (University of Minnesota) Massachusetts Department of Elementary and Secondary Education: Rita Brennan-Olson, Linda Fischer, Mary Anne Gilbert and Katie Millett Harvard School of Public Health: Juliana Cohen, Jessica Garcia and Eric Rimm Boston Public Health Commission: Kathy Cunningham John C. Stalker Institute of Food and Nutrition at Framingham State University: Karen McGrail Together with the Massachusetts schools that contributed successful examples for promoting healthy eating policies and practices for this guidance document, we would also like to recognize the significant efforts of the Massachusetts Public Health Association, the Massachusetts Farm-to-School Project, and the Massachusetts School Nutrition Association in helping us translate the regulations into practical guidelines that may help all public schools in the Commonwealth be successful in promoting healthy nutrition.
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Introduction
The Act Relative to School Nutrition, signed into law on July 30, 2010, requires the Massachusetts Department of Public Health to establish standards for competitive foods and beverages sold or provided in public schools during the school day. The goal of the standards is to ensure that public schools offer students food and beverage choices that will enhance learning, contribute to their healthy growth and development, and cultivate life-long healthy eating behaviors. The regulations are part of the Commonwealths broad-based, collaborative initiative to reduce childhood obesity and prevent its complications in childhood and later in adulthood.
The Massachusetts Department of Public Health worked with the Massachusetts Department of Elementary and Secondary Education, the Harvard School of Public Health, the Boston Public Health Commission, the John C. Stalker Institute of Food and Nutrition at Framingham State University and other key partners to develop the nutrition standards which are based primarily on the Institute of Medicines Nutrition Standards for Foods in Schools and the Dietary Guidelines for Americans, 2010. The nutrition standards and the associated regulations go into effect on August 1, 2012 unless otherwise noted. The regulations apply to competitive foods and beverages sold or made available in public schools. They do not apply to foods and beverages sold as part of a federal
INtroduCtIoN
nutrition program such as the School Breakfast Program, School Lunch Program, or the Child and Adult Care Food Program (all of which follow USDA national guidelines). Competitive foods are defined as foods and beverages provided in: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. School cafeterias offered as la carte items School buildings, including classrooms and hallways School stores School snack bars Vending machines Concession stands Booster sales Fundraising activities School-sponsored or school-related events Any other location on school property
The regulations apply to competitive foods and beverages sold or provided to students 30 minutes before the beginning of the school day until 30 minutes after the school day ends. However, foods and beverages sold in vending machines must comply with the standards at all times. The time frame stated in the legislation establishes the minimum standard to be followed in applying the competitive food and beverage regulations. School districts may choose, and are encouraged, to go beyond the minimum standards to establish local policies that apply the food and beverage standards at all times to promote a healthy school environment throughout the entire day. Additional school nutrition food and beverage regulations listed in the bill include: making water available to all students during the day without charge, offering for sale fresh fruits and non-fried vegetables at any location where food is sold, except in non-refrigerated vending machines and vending machines offering only beverages, prohibiting the use of fryolators for competitive foods and, by August 1, 2013, making nutrition information available to students for non-prepackaged competitive foods and beverages served in the cafeteria. The information in this guide is intended to offer practical ideas for implementing the Massachusetts School Nutrition Regulations for school administration and staff, parent groups, student groups, and youth and youth-serving organizations. It is also available electronically at www.mass.gov/dph/healthierschools. School-specific communication plans can help school staff, teachers, food service personnel, school nurses, athletic department staff, students, parents, booster clubs, vendors, etc., understand their roles in working together to put the standards into practice. Many Massachusetts school districts have already implemented several of the laws requirements on their own, and examples of their thoughtful and creative initiatives can be found throughout this guide.
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Definitions
la carte entre means a single food or combination of foods offered as a main course or central focus of a meal, generally a protein source. When applying the standards, the food product should be analyzed as a whole, not by the individual ingredients that make up the product. For example, a turkey sandwich would include the bread, condiments, turkey, etc. Artificial sweeteners means substances added to food or beverages to provide a sweet taste while providing few or no additional calories, including aspartame, sucralose, acesufame-K, neotame, sugar alcohols and saccharin. Standards for fluid milk and milk substitutes are defined by the USDA: All milk served must be pasteurized fluid milk which meets state and local standards for such milk. All milk must have vitamins A and D Nutrients Required for Non-Dairy Beverages at levels specified by the and Milk Substitutes (USDA)* Food and Drug AdminNutrient Nutrient per 8 Ounces istration and must be Calcium 276 mg consistent with state and Protein 8g local standards for such Vitamin A 500 IU milk. Nondairy beverages Vitamin D 100 IU must provide the nutrients listed in the following table. Magnesium 24 mg Milk substitutes must be Phosphorus 222 mg fortified in accordance with Potassium 349 mg fortification guidelines isRiboflavin 0.44 mg sued by the Food and Drug Vitamin B-12 1.1 mcg Administration. Fresh means fresh, frozen, dried or canned without added sugar, fat or sodium for the purpose of these regulations. Grain-based products means food products in which the primary ingredient is grain, including pasta, crackers, granola bars, chips and bakery items. Item means one serving of a product; packaged items can contain no more than one serving per package. Low-fat means 3 grams or less per Reference Amount Customarily Consumed (RACC) standards established by the federal Food and Drug Administration.
*Source: http://edocket.access.gpo.gov/cfr_2011/janqtr/pdf/7cfr210.10.pdf
deFINItIoNS
Natural flavorings means the essential oil, oleoresin, essence or extractive, protein hydroplysate, distillate, or any product of roasting, heating or enzymolysis, which contains the flavoring constituents derived from a spice, fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products, or fermentation products thereof, whose significant function in food is flavoring rather than nutritional. Public school means an elementary, middle, high, charter, innovation or comparable school operated by a public school district or board of trustees pursuant to Chapter 71 of the Massachusetts General Laws. Reduced fat means at least 25% less fat per Reference Amount Customarily Consumed (RACC) than an appropriate reference food. School day means the hours of the day that students must attend school. Sweetener means a substance derived from a natural product that is added to food or beverages to provide a sweet taste. Such a substance may be nutritive or nonnutritive. A nutritive sweetener may be either naturally occurring, such as honey, or refined from plants, such as sugar from sugar cane. Nonnutritive sweeteners include products that may be regarded as natural. Trans fat-free means less than 0.5 grams of trans fat per item, or as otherwise specified by the federal Food and Drug Administration. Whole grains means grains or the foods made from them that contain all the essential parts and naturally occurring nutrients of the entire grain seed. If the grain has been processed, the food product should deliver approximately the same balance of nutrients found in the original grain seed. For purposes of these regulations, whole grain should be the primary ingredient by weight (i.e., whole grain listed first in the ingredient statement).
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Massachusetts School Nutrition Regulations for Competitive Foods and Beverages At-a-Glance
The following standards apply to all public elementary, middle and high school students. To view the complete regulations see www.lawlib.state.ma.us/source/ mass/cmr/cmrtext/105CMR225.pdf. Category Juice Juice Portion Size Limit Milk (Including alternative milk beverages such as lactose-free and soy) Milk Portion Size Limit (Including alternative milk beverages such as lactose-free and soy) Milk Added Sugar (Including alternative milk beverages such as lactose-free and soy) Water Standards 100% fruit and vegetable juice, with no added sugar. No more than 4-ounce servings. Low-fat (1% or less) and fat-free milk.
Flavored milk with no more than 22 grams total sugar per 8 ounces.
No added sugars, sweeteners or artificial sweeteners. May contain natural flavorings and/or carbonation.
Any beverages with added sugar or sweeteners not already prohibited will be phased out by August 1, 2013. A school may provide or sell flavored milk or milk substitutes that contain the same amount or less sugar than plain, fat-free or low-fat milk. No beverages other than juice, milk, milk substitutes and water shall be sold or provided.
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Category Calories
Standards Foods shall not exceed 200 calories per item. la carte entres shall not exceed the calorie count of entre items offered as a part of the National School Lunch Program (e.g., equivalent portion size).
Fat Saturated Fat Trans Fat Fat Exemptions (All other categories apply, e.g., sugar and calories.) Sugar Sugar Exemptions (All other categories apply, e.g., fat and calories.) Sodium
No more than 35% of total calories from fat. No more than 10% of total calories from saturated fat. All foods shall be trans fat-free. 1-ounce servings of nuts, nut butters, seeds, and reduced-fat cheese.
No more than 35% of total calories from sugars. 100% fruit with no added sugar. Low-fat or non-fat yogurt (including drinkable yogurt) with no more than 30 grams of total sugars, per 8-ounce serving. No food shall contain more than 200 mg of sodium per item. la carte entres shall not contain more than 480 mg of sodium per item.
Grains
All bread or grain-based products shall be whole grain, i.e., whole grain should be listed first in the ingredient statement. These include crackers, granola bars, chips, bakery items, pasta, rice, etc. No food or beverage shall contain more than trace amounts of caffeine. Note: Some foods and beverages, such as chocolate, contain small amounts of naturally occurring caffeine. These products are allowed as long as they comply with the rest of the nutrition standards.
Caffeine
Artificial Sweeteners
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Competitive Foods and Beverages That Meet Massachusetts School Nutrition Standards
The John C. Stalker Institute of Food and Nutrition (JSI), a partnership of the Massachusetts Department of Elementary and Secondary Education and Framingham State University, publishes the A-List (or Acceptable List) which is a list of products that meet the Massachusetts Action for Healthy Kids Massachusetts la carte Food & Beverage Standards. This list of products will be revised to reflect the Massachusetts School Nutrition Regulations. The revised list is expected to be published in February, 2012. Please see www.johnstalkerinstitute.org/alist. JSI will be creating a nutrition calculator that schools can use to determine if an individual product meets the Massachusetts standards. The calculator is expected to be completed by the summer of 2012 and will also be featured on the JSI website. It is important to note that some processed foods will meet the nutrition standards, however, processing food can reduce the naturally occurring trace nutrients such as vitamins and minerals as well as fiber in a product. Some products are enriched with these nutrients after processing, but never to the same degree as in the natural food. The objective of the Massachusetts School Nutrition Standards is to provide the opportunity for children to consume whole, minimally processed, nutrient-rich foods, such as fruits, vegetables, whole grains, lean protein and low-fat dairy. Please see page 38 for frequently asked questions regarding the rationale that supports a number of these nutrition standards.
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For more ideas and information on making water available for students, see the following resources:
Drinking Water Access in Schools, The National Policy & Legal Analysis Network to Prevent Childhood Obesity www.phlpnet.org/childhood-obesity/ products/water-access-in-school The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages www.eatsmartmovemorenc.com/ TheEvidence/Texts/StratstoReduce_Sugar_ Sweetened_Bevs.pdf Water in Schools Toolkit, California Food Policy Advocates http://waterinschools.org Proper Care of Bottled Water and Dispensers for Schools, Massachusetts Department of Environmental Protection www.mass.gov/dep/water/drinking/ dispcare.htm Lead in School Drinking Water Program, Massachusetts Department of Environmental Protection www.mass.gov/dep/water/drinking/ sclcatlg.pdf
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For more information on offering fresh fruits and vegetables, see the following resources:
USDA Fresh Fruit and Vegetable Program State and Local Resources www.fns.usda.gov/cnd/FFVP/locallydeveloped.htm Creating Demand for Fruits and Veggies, Produce for Better Health Foundation www.pbhfoundation.org UMASS Extension Nutrition Education Program Materials http://extension.umass.edu/nutrition/ images/stories/publications/food_exp_ highschool_posters/March_banana_hs_ poster_09.pdf The Massachusetts Farm-to-School Project helps to match local farmers and schools to build sustainable food purchasing relationships. They also sponsor the annual Massachusetts Harvest for Students Week in September. www.farmtoschool.org/MA
2. Offer for sale fresh fruits and non-fried vegetables at any location where food is sold, except in non-refrigerated vending machines and vending machines offering only beverages.
Every step taken towards eating more fruits and vegetables helps childrens health. Fruits and vegetables are rich in vitamins and minerals as well as fiber, and are low in calories. They can help children maintain a healthy weight and reduce the risk of developing chronic diseases such as diabetes, heart disease, stroke and cancer. Some Massachusetts schools have offered fresh fruits and vegetables as snacks and have found that students choose more fruits and vegetables for lunch as well. There are approximately 100 schools in 25 districts in Massachusetts participating in the USDA Fresh Fruit and Vegetable program. This program targets schools in which more than 50% of students are eligible for free or reducedprice meals. The goal of the program is to provide healthier food choices by expanding the variety of free fresh fruits and vegetables made available to students throughout the school day outside of the meal service. Participating schools offer fresh fruits and vegetables in a variety of ways, including hallway kiosks or vending carts and baskets of fruit delivered to classrooms for mid-morning or afternoon snacks. For more information on the USDA Fresh Fruit and Vegetable Program, see www. fns.usda.gov/cnd/FFVP/FNSresources.htm.
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4. By August 1, 2013 make nutrition information available to students for non-prepackaged competitive foods and beverages served in the cafeteria. (This regulation does not apply to fresh fruit or vegetables.)
Readily available nutrition information can help students make healthier choices. This information is most effective when it is right at the point-of-purchase, such as on school menu boards, but may also be provided on the schools website. Recent studies conducted in several major restaurant chains have shown that many customers who used calorie information on menu boards made lower-calorie choices. A study commissioned by Healthy Eating Research examined whether New York Citys menu-labeling requirement, which was implemented in 2008, changed what customers purchased for lunch. Researchers found that one in six customers used calorie information to purchase lowercalorie meals. They also found that customers who used the calorie information purchased on average 106 fewer calories than customers
vegetable grant, students are more open to trying all new foods and dont hesitate to ask for new foods to be on the menu!
who did not see or did not use the information (www.rwjf.org/childhoodobesity/digest. jsp?id=24562). The range of resources that will be necessary to help schools make nutritional information available to students, including software available; training time, resources and costs; and strategies for phasing in nutrition analysis, is currently being assessed. Further guidance will be made available to schools as the rollout of the regulations goes forward.
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Resources for implementing fresh fruit fundraisers: Florida Fruit Association Fundraising www.fundraisingfruit.com Parker Indian River Groves Citrus Fruit Fund Raising www.citrusfruit.com Fruit Fundraising Companies www.fundraisingweb.org/listings/citrus.htm
Healthy Celebrations
Classroom parties such as birthday and holiday celebrations do not need to involve food, just fun! Let the birthday boy or girl be the teachers assistant for the day, have a celebration dance, give the class extra recess time, or have students create arts and crafts projects to decorate the classroom or bring home to their families, e.g., snow globes, holiday cards, collages or flower pots. Check out the following resources for additional healthy classroom celebrations: Healthy Classroom Celebrations, Center for Science in the Public Interest http://cspinet.org/new/pdf/healthy_ school_celebrations.pdf Healthy School Parties, Alliance for a Healthier Generation www.healthiergeneration.org/schools. aspx?id=3296 Guide to Healthy School Parties, Action for Healthy Kids of Alabama www.actionforhealthykids.org/resources/ files/alafhk-healthy-school-parties.pdf
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While not required in the Massachusetts School Nutrition Regulations, the following are practical strategies that are known to support healthy eating behaviors. The school wellness policy is an effective tool in helping school wellness advisory councils and districts establish specific standards such as the ones listed below to create healthy school environments. To build support around implementing these types of voluntary practices, it is valuable to share school-level health statistics with the school community. Since 2010 every public school in Massachusetts has been required to measure the height and weight of students in grades 1, 4, 7 and 10 and use those figures to calculate their Body Mass Index (BMI). BMI is a method of determining if a child has a healthy weight compared to other children of the same age and sex. This information is available at every school, and can be used as a compelling tool to illustrate the need for adapting these healthy recommendations.
Foods and beverages should not be used as rewards or discipline for academic performance or behavior.
Providing food based on performance or behavior connects food to mood and teaches children to reward themselves by eating even when they are not hungry. The article, Do Food Rewards Make Kids Overweight? (www.schoolnutrition.org/ Content.aspx?id=7176) published in the December 2005 issue of the Archives of Pediatrics and Adolescent Medicine, concluded that policies in schools that allow students to snack frequently; to consume high-calorie, low nutrient-dense foods and beverages; and to have food as incentives and rewards were associated with higher body mass indices in middle-school students. There are numerous alternative rewards that can be used instead of food to provide positive reinforcement for students such as holding class outdoors, giving extra
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credit, non-food items such as stickers and temporary tattoos, and awarding individual privileges like going first. For more ideas, see the following resources: Constructive Classroom Rewards, Center for Science in the Public Interest (CSPI) http://cspinet.org/new/pdf/constructive_ classroom_rewards.pdf Alternatives to Food as Reward, Connecticut State Department of Education www.sde.ct.gov/sde/lib/sde/PDF/DEPS/ Student/NutritionEd/Food_Rewards.pdf Classroom Rewards, North Carolina Action for Healthy Kids www.actionforhealthykids.org/assets/ clubs/nc7-classrewards.pdf
All marketing of foods and beverages should be restricted to items that meet the nutritional standards.
The National Policy and Legal Analysis Network to Prevent Childhood Obesity asserts that students health-related choices are influenced by many factors, but advertising plays a key role in their decision-making. Schools efforts to teach students how to make informed choices about nutrition can be impeded if students are subjected to advertising on school property that contains messages contrary to or inconsistent with the health information contained in the schools curriculum. For more information on establishing policies that restrict food and beverage advertising, see the following resources: District Policy for Restricting Food and Beverage Advertising on School Grounds, National Policy and Legal Analysis Network www.nplanonline.org/nplan/products/ district-policy-restricting-food-and-beverageadvertising-school-grounds
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Captive Kids: Selling Obesity at Schools. An Action Guide to Stop the Marketing of Unhealthy Foods and Beverages in School, California Project LEAN www.californiaprojectlean.org/ docuserfiles//Captive%20Kids2007.pdf
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A Guide to Taste Testing Local Foods in Schools, Vermont Food Education Every Day (VT FEED) www.vtfeed.org/materials/guide-tastetesting-local-foods-schools Making It Happen! School Nutrition Success Stories: Adopt Marketing Techniques to Promote Healthful Choices, USDAs Team Nutrition and the Centers for Disease Control and Preventions Division of Adolescent and School Health www.fns.usda.gov/tn/resources/k_app4.pdf Healthy School Tool Kit, The Food Trust www.thefoodtrust.org/catalog/download. php?product_id=144 New Look of School Milk, New England Dairy and Food Council www.newenglanddairycouncil.org/page/ new-look-of-school-milk
Street vendors should be prohibited from selling food within 200 yards from a school.
Many street food vendors sell items that offer empty calories without nutritional value. Children who fill up on these snacks will be less interested in the healthier breakfast and lunch options in school. Schools should work with municipal licensing authorities to establish if, when, or what foods and beverages may be sold by outside street food vendors near schools. Another way to handle this issue is to include it in the school districts wellness policy. Boston Public Schools recently added Food Trucks on School Grounds to their list of competitive foods that are covered by their nutritional guidelines. For more information on policies restricting vendors near school campuses, see the following resources: Policy Bulletin Vendors at or Near School Campuses, Los Angeles Unified School District
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http://lausd-oehs.org/docs/Bulletins/BUL4994.pdf Model Ordinance: Healthy Food Zone, National Policy and Legal Analysis Network www.nplanonline.org/nplan/products/ model-healthy-food-zone-ordinance
Nutrition regulations should be applied at all times, including evening and community events.
Although the minimum requirement for applying the Massachusetts School Nutrition Regulations is 30 minutes before the start of the school day through 30 minutes after the school day ends, school districts are encouraged to apply the nutrition standards at all times. It is important for schools to be consistent in promoting a healthy school environment, and implementing the standards 24/7 prevents sending mixed messages to students. School districts or boards of trustees may elect to regulate the nutritional standards beyond this timeframe or School Wellness Advisory Committees may develop and implement regulations within the School Wellness Policy.
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Meals should also be scheduled at appropriate times, e.g., lunch should be scheduled as close to the middle of the day as possible between 11 a.m. and 1 p.m. so that students dont go for long periods of time without eating. Activities such as tutoring, clubs, and organizational meetings as well as school announcements should not be scheduled during meal times.
Farm-to-School Initiatives should be implemented to enhance access to fresh, locally grown produce.
When schools purchase produce directly from Massachusetts farms, students will have access to locally grown fresh fruits and vegetables which are generally fresher and tastier. This practice has the added benefit of supporting the state agricultural economy and helping create enhanced and steady revenue streams for Massachusetts farmers. Exposing students to a variety of fruits and vegetables 28
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gives them the opportunity to taste foods they may never have tried or seen before in their natural, fresh state. For more information on farm-to-school strategies, see the following resources: The Massachusetts Farm-to-School Project helps to match local farmers and schools to build sustainable food purchasing relationships. www.farmtoschool.org/MA Farm-to-School Toolkit provides resources for farms, schools, families and communities to help meet their farm-to-school goals, Washington State Department of Agriculture. www.wafarmtoschool.org
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Eat Well and Keep Moving An Interdisciplinary Curriculum for Teaching Upper Elementary School Nutrition and Physical Activity www.eatwellandkeepmoving.org Fertile Ground creates comprehensive experiential learning programs that teach school children about growing food and create opportunities for them to delight in fresh vegetables through teaching gardens, classroom cooking, harvest celebrations, and visits to local farms. www.fertilegroundschools.org Seeds of Solidarity is a nonprofit organization that provides practical tools for schools to use renewable energy to grow food. www.seedsofsolidarity.org
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For more information on nutrition education for parents and families, see the following resources: Families as Partners: Fostering Family Engagement for Healthy and Successful Students, a resource to help school leaders effectively engage families in schools, particularly around school health issues, National School Board Association www.nsba.org/Board-Leadership/ SchoolHealth/Family-Engagement-in-Health/ Families-as-Partners.pdf Balancing Act provides healthy lifestyle ideas and resources for families, Harvard Pilgrim Health Foundation www.harvardpilgrim.org/pls/portal/docs/ PAGE/MEMBERS/FOUNDATION/GROWINGUPHEALTHY-BALANCING-ACT.PDF Fuel Up to Play 60 At Home Tools for Parents, National Dairy Council and the National Football League http://school.fueluptoplay60.com/tools/ nutrition-education/at-home-tools.php We Can, National Heart, Lung and Blood Institute www.nhlbi.nih.gov/health/public/heart/ obesity/wecan
Gardens in Framingham
Thanks to the vision of the Nutrition Services Director of Framingham Public Schools, new vegetable, fruit, and herb gardens are in full bloom at Framingham High School. These community gardens promise to inspire student learning, healthy eating, and town pride. When fully completed, the Saxonville Gardens will include a large vegetable garden, a small herb garden, and blueberry/raspberry bushes in the courtyard behind the cafeteria at Framingham High School. The gardens will be watered by an irrigation system, creating a sustainable growing environment that will be a permanent part of the community. Like the Obama Garden at the White House, this garden will be organic and three times the size! Organized by the Environmental Club at the high school, a group of 15 students work all summer with the lead grower, a senior who just graduated. Through this initiative, students from many organizations such as the Honor Society and football team are able to do community service as well. The goal of the initial plantings (including plum tomatoes, peppers, eggplant, carrots, herbs and flowers) is to produce 1,200 gallons of tomato sauce as well as a large crop of cantaloupe that will be served in all schools in the 2011-2012 school year. Over the longer term, students throughout the District will participate in the Saxonville Garden Project and will eat vegetables, fruits, and herbs from the garden in the school as well as sell them at farmers markets.
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Dollars and Sense: the Financial Impact of Selling Healthier School Foods, the California Endowment www.calendow.org/uploadedFiles/ Publications/Publications_Stories/4146_ tce_heac_program_midpoint.pdf On the next page is a table of relevant studies documenting intervention effects on school revenue.
For more information on the USDA School Breakfast Program, see the following resources: www.fns.usda.gov/cnd/breakfast and www.meals4kids.org/sb/breakfast.html For information on the Project Bread study, see: www.projectbread.org/site/DocServer/ ProjectBread_BreakfastStudy. pdf?docID=1861&AddInterest=1421
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Limit fats, sugars, portion sizes. Increase offerings of whole grains, fruits, and vegetables.
1 Pilot school in San Francisco (859 students in grades 68); expanded to 40 middle/high schools in San Francisco Unified School District
Limit fats, sugars, portion sizes. Increase offerings of fruits and vegetables as snacks.
Retrospectively compared school revenue and lunch participation data from the 20022003 school year (pre-implementation) vs. 20032004 school year (post implementation) for both the pilot middle school and the district as a whole.
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Impact on Competitive Food Revenues The 7 schools that offered foods via vending, la carte or school stores showed no negative financial impacts after making healthy changes to their food selections.
8 of 14 sites eliminated la carte food offerings (therefore decreasing la carte revenues). 6 of 14 sites offering la carte foods experienced decreases in la carte sales of 29%56% (due to lower profit margins for compliant items and fewer per capita purchases).
14 of the 16 sites had gains in lunch sales of 1% to 122%. 12 of the 15 sites with breakfast programs reported increased breakfast sales of 2%173%.
13 out of 16 sites had increases in food service per capita gross revenues (reimbursable meals plus la carte) from year 1 to year 2.
The 5 intervention schools experienced decreases in la carte sales of 11.8%31.1%. 1 of the 3 control sites also experienced decreases in la carte sales of 10.6% (the other two experienced increases of 2.02.5%). 2 of 39 (5.1%) schools with available data had an increase in la carte/ snack bar sales. Schools lost an average of $13,155 in sales.
In 20032004 school year, overall participation in the lunch program increased at both middle and high schools. 22 schools (55%) showed increases in sales. Schools had a mean increase in sales of $1,706.
Pilot school generated over $2000 in revenue. Compiled data on profits for the other 40 schools were not available.
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Other Resources
Grants
Massachusetts Agriculture in the Classroom www.aginclassroom.org/ html/Awards_Grants/ awards_grants.html Fuel Up to Play 60, National Dairy Council and the National Football League http://school. fueluptoplay60.com/ funds/funds_for_futp60. php School Garden Grants, Whole Kids Foundation www.wholekidsfoundation. org/gardengrants.php Love Your Veggies program, Hidden Valley Salad Dressings www.hiddenvalley. com/veggies/gardenclassroom-about Lets Move Salad Bars to Schools Grant Program, a collaboration of the Food, Family, Farming Foundation, the National Fruit and Vegetable Alliance, United Fresh Produce Association Foundation, and Whole Foods Market to support the Lets Move! initiative
to significantly increase access to salad bars in schools across the country. http://saladbars2schools. org/?source=govdelivery
Obesity
Childhood Obesity in Massachusetts: Causes and Costs of Childhood Obesity, Susan Feinman Houghton, M.A., Ph.Dc., and Michael Doonan, Ph.D., MA Health Policy Forum F as in Fat: How Obesity Policies are Failing in America, Trust for Americas Health www.healthyamericans.org
Nutrition
Mass in Motion was launched in January 2009 by the Commonwealth to promote wellness and to prevent overweight and obesity in Massachusetts. The website provides resources and information for individuals on how to eat more healthfully and how to be more physically active. The website also has resources to help develop and implement
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policies that support healthy eating and active living in schools, within communities and in the workplace. www.mass.gov/ massinmotion The John C. Stalker Institute of Food and Nutrition Resource Center connects you with a variety of online child nutrition and wellness resources. www.delicious.com/ jsireflib Dietary Guidelines for Americans 2010 with MyPlate Resources www.health.gov/ DietaryGuidelines Promoting Healthier Foods and Beverages in US Schools www.cdc.gov/Features/ SchoolNutrition Making It Happen! School Nutrition Success Stories, from USDAs Team Nutrition and the Centers for Disease Control and Preventions Division of Adolescent and School Health, shares stories from 32 schools and school districts that have made innovative changes to improve the nutritional
quality of all foods and beverages offered and sold on school campuses. http://teamnutrition. usda.gov/Resources/ makingithappen.html The Action for Healthy Kids website features information, research, reports, facts and supporting materials to help you help a school become a healthier place. www.actionforhealthykids. org/resources Lets Move! is a comprehensive initiative, launched by the First Lady, dedicated to solving the problem of obesity within a generation, so that children born today will grow up healthier and able to pursue their dreams. The program combines comprehensive strategies with common sense and provides helpful information to foster environments that support healthy choices. www.letsmove.gov The Renegade Lunch Lady, Chef Ann Cooper, provides ideas, strategies, tips and recipes for schools to create healthy foods and beverages to ensure that
kids everywhere have wholesome, nutritious, delicious food at school. www.chefann.com Fuel Up To Play 60 is an in-school nutrition and physical activity program by National Dairy Council (NDC) and National Football League, in collaboration with United States Department of Agriculture (USDA). www.newenglanddairy council.org/page/fuel-upto-play-60-2
otHer reSourCeS
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Why dont the standards apply to the food in the federal nutrition program?
While there previously have been no standards for competitive foods, the federally reimbursable school meal program is regulated by the USDA Food and Nutrition Service. For more information on school meals nutrition standards, see www.fns.usda.gov/fns.
The Act Relative to School Nutrition does not apply to preschools. However, preschools are encouraged to adapt them. Preschool administrators and staff can utilize resources that are available for implementing on-site nutrition standards for child care centers, e.g., the Mass Children at Play Initiative, which uses the Head Start I am Moving, I am Learning curriculum and the NAP-SACC nutrition and physical activity policy development tool available for child care center directors. For more information see the following resources: MA Children at Play Initiative www.mass.gov/eohhs/docs/dph/com-health/school/mcapprovider-brochure.pdf I am Moving, I am Learning Curriculum (Head Start) www.choosykids.com/CK2/links/2008/10/i_am_moving_i_ am_learning_jour.html
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Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) www.napsacc.org Recommended Daily Meal Patterns with Description of Allowable Foods, IOM Child and Adult Care Food program www.iom.edu/~/media/Files/Report%20Files/2010/Childand-Adult-Care-Food-Program-Aligning-Dietary-Guidance-for-All/ CACFP%202010%20Detailed%20Information.pdf Lets Move Child Care provides tools for parents and child care providers to help reach healthy nutrition and physical activity goals from infancy to preschool. www.healthykidshealthyfuture.org/welcome.html Do the standards apply to before- and afterschool programs?
The regulations apply to competitive foods and beverages sold or provided 30 minutes before the beginning of the school day until 30 minutes after the school day ends, and foods and beverages sold in vending machines must comply with the standards at all times. Outside of this time frame, schools may choose to offer foods and beverages that do not meet the school nutrition standards for competitive foods. The time frame stated in the legislation establishes the minimum standard to be followed in applying the competitive food and beverage regulations. School districts are encouraged to go beyond the minimum standards and establish local policies that apply the food and beverage standards at all times to promote a healthy school environment throughout the day.
The goal of the regulations is to ensure that students are offered nutritious food and beverage choices. Although we hope that adults model healthy eating behaviors for students, the regulations do not specifically apply to adults. On a local level, a wellness policy could address standards for adults and staff.
How are you planning to monitor compliance and enforce the new regulations?
The School Nutrition Bill is a state law and school districts must be in compliance. We encourage local oversight by school district administration and wellness committees. The responsibility for implementing and enforcing the standards should be a school-wide effort and includes all departments that oversee the purchase or provision of competitive foods, such as teachers, athletic directors, school nutrition services, principals, etc. Additionally, a monitoring process is currently in development in conjunction with the new USDA requirements for school meals and competitive foods.
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School districts and school programs need to follow federal, state and local procurement requirements for purchasing foods, and this applies to the new nutrition standards starting August 1, 2012. Massachusetts General Law Chapter 30B explains purchasing requirements: www.malegislature.gov/Laws/ GeneralLaws/PartI/TitleIII/Chapter30B.
Workshops and courses offered by the John C. Stalker Institute of Food and Nutrition at Framingham State University target professionals in the school nutrition environment. Visit www. johnstalkerinstitute.org for current training opportunities.
As this requirement may involve additional computer programming for some schools, it does not go into effect until August 1, 2013, a year after the rest of the requirements. The John C. Stalker Institute of Food and Nutrition at Framingham State University will be creating a nutrition calculator that schools can use to determine if an individual product meets the Massachusetts standards. The calculator is expected to be completed by the summer of 2012 and will be featured on the JSI website.
How can parents find out what foods and beverages are served to their children at school? How do these regulations address oral health issues?
Some schools post information on foods served in the cafeteria on their websites. But since all schools dont have the same resources and/or dont operate with the same formats, its best to contact the school for specific information.
Oral health practitioners note that while some foods and drinks may be considered healthy for the body, they may not be healthy for teeth. Tooth decay is the most common chronic disease of childhood and every child is susceptible. Bacteria in the mouth produce acids from sugary foods and beverages, which soften the outer surface of the tooth (enamel) and causes tooth decay. Therefore, it is important to choose foods that will not increase a childs risk for tooth decay. Foods and drinks made of simple carbohydrates, sugar and/or foods that are sticky to the touch will also stick to the teeth. Some examples of these foods are crackers and chips, as well as dried fruits, soda and other sugarbased drinks. They recommend serving foods that are not only healthy for the body, but that promote dental health as well.
What is the rationale behind the decision to phase out flavored milk?
Establishing consensus regarding the regulation to phase out flavored milk was the result of a thoughtful and long-deliberated dialogue over the course of several months. Looking at the evidence available, the work group found that there are mixed study results on the short-term decrease of milk
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consumption when flavored milk is removed from schools. There is one study (The Impact on Student Milk Consumption and Nutrient Intakes from Eliminating Flavored Milk in Schools) conducted by the Milk Processors Education Program in 2010 and a couple of small, time-limited case studies that indicated a drop in consumption of milk products when sweetened products were discontinued. On the other hand, a small number of case studies, including one school in Somerville and two in Boston, have found that there would be negligible, if any, drop in consumption. Other school districts that have eliminated flavored milk in the past year, including Washington, D.C., Berkley, CA and Boulder, CO, have not had any issues. School Districts in Minneapolis, MN and Los Angeles, CA are planning to eliminate flavored milk in the 2011-2012 school year. While the Institute of Medicine and USDA allow flavored milk to be included in their guidelines, the national Centers for Disease Control and Prevention (CDC) and the First Ladys Office (Lets Move! Campaign www.healthykidshealthyfuture.org/nutrition/ beverages.html) consider flavored milk a sugar-sweetened beverage as it has almost as much sugar as soda and, therefore, exclude it from their nutrition recommendations for schools and child care centers. The reduction and/or elimination of sugarsweetened beverages in the diet is one of the CDCs five primary strategies to reduce the prevalence of overweight and obesity in children and adults in the United States.
Sugar-sweetened beverages (SSBs) are the largest source of added sugar and an important contributor of calories in the U.S. diet. SSBs also tend to have few, if any, other nutrients. While the definitions used by researchers have varied, we define SSBs to include soft drinks (soda or pop), fruit drinks, sports drinks, tea and coffee drinks, energy drinks, sweetened milk or milk alternatives, and any other beverages to which sugar, typically high fructose corn syrup or sucrose (table sugar), has been added ... Although the presence of protein and other nutrients differentiates sweetened milk and alternative milk beverages from other SSBs, adding sugar to plain milk can substantially increase the calories per serving without increasing the overall nutrient value of the drink. Centers for Disease Control and Prevention www.cdph.ca.gov/SiteCollectionDocuments/StratstoReduce_ Sugar_Sweetened_Bevs.pdf
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Since we cant predict if students will or will not drink plain milk, and if milk is a key source for calcium, how will schools ensure that they will receive adequate nutrition if theyre not drinking any milk at all?
This was a major part of the discussion around phasing out flavored milk. As noted previously, the evidence available in the studies on the short-term decrease of milk consumption when flavored milk was removed from schools, together with the experiences reported by the cities noted above, supported the expectation that there would be a negligible drop in consumption of milk, if at all. To help implement this regulation, this requirement does not take effect until August 1, 2013, a year after the rest of the requirements. Schools can also help students become accustomed to drinking plain, low-fat or fat-free milk by gradually phasing out flavored milk, e.g., serving flavored milk only one to two times per week during the preceding school years. Additionally, to support school efforts in promoting the sale of non-flavored milk to students, the John C. Stalker Institute for Food and Nutrition at Framingham State University offers training programs for food service directors and staff on how to market low-fat and non-fat milk (e.g., using colorful plastic milk containers instead of paper cartons and providing adequate refrigeration), and other calcium-rich dairy products, such as lowand non-fat yogurt and cottage cheese.
Given the extent of the obesity problem, why arent artificial sweeteners allowed?
There is little evidence on the long-term health effects of nonnutritive sweeteners, particularly from exposure initiated in childhood. Some research suggests that non-nutritive sweeteners can increase cravings for sweet foods and lead to increased calorie consumption (www.ncbi.nlm.nih.gov/pmc/articles/ PMC2892765 and www.hsph.harvard.edu/nutritionsource/ healthy-drinks/sugary-vs-diet-drinks). Additionally, children need to enjoy the natural flavors of healthy foods that have not been artificially enhanced with a sweet taste.
Some national standards set limits on added sugar as a percent of total sugar by weight, where the total grams of sugar are compared to the total gram weight of the product. Why do you set limits on added sugar as a percent of calories instead of weight?
According to the IOM, criterion based on weight unfairly favors foods higher in moisture content at the expense of drier foods that may be rich in a variety of nutrients (e.g., cereals and granola bars). A standard based on calories, such as 35 percent of calories as total sugar is still a realistic calculation to do and would allow for a greater variety of products especially ones that are less moist in nature to be provided. A measure based on total calories instead of weight is a reasonable option until analytical methods and labeling regulations are established to measure and label the added sugar content of foods and beverages (www.nap.edu/openbook. php?record_id=11899&page=59). It would also be confusing and inconsistent to have fat measured as percent of calories and sugar as percent by weight.
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I understand youre using the accepted FDA definition of whole grain, which does not require grain-based products to be 100% whole grain. Why dont you require 100% whole grains for all grain-based foods? Why dont you address fiber in the regulations?
The FDA standard, which requires that the majority of the grains in products are whole grain, is consistent with federal regulations for whole grains. This requirement considers the availability of existing products, the costs of whole grain foods, as well as the texture and palatability of grain products. Schools are encouraged to purchase 100% whole grain products when available.
IOM did not specifically mention a fiber requirement because of the emphasis on fruits, vegetables and whole grains, all of which contain a significant amount of fiber. Additionally, fiber is added to many products that are not made with whole grains, and adding this guideline could be confusing.
The Dietary Guidelines for Americans 2010 set the recommendation for a standard serving size of juice at 4 ounces (for both adults and children). According to the CDC, fruits can enhance satiety the feeling of having had enough especially when consumed whole; whole fruit provides more satiety than fruit juices.
Caffeine is a natural chemical (and not a nutrient) found in such items as cacao, which is used to make chocolate. Since it occurs naturally in these products, it is not listed on their ingredients labels. However, the amount of naturally-occurring caffeine in these items is minimal so they are allowed if the product otherwise complies with the standards. If caffeine is added to a food or beverage, it must be included in the listing of ingredients required on food product labels. These items would not be allowed as significant amounts of caffeine have the potential for adverse health effects such as physical dependency and withdrawal (http://books.nap.edu/openbook. php?record_id=11899&page=52).
Do fruit products that contain 100% fruit plus water meet the 100% fruit with no added sugar exemption? Does frozen yogurt meet the low-fat or non-fat yogurt sugar exemption?
Yes, fruit products containing water, such as applesauce or 100% fruit juice/water mixtures, do meet the exception as long as no other ingredients are added.
No, frozen yogurt is typically consumed as a dessert item, and unlike regular yogurt, it is not considered a meat/meat alternate and cannot be credited in the meal patterns for the USDA Child Nutrition Programs.
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Dear Parent or Guardian: The [name of school district or region] wants to provide a healthy school environment for all students. That means offering nourishing food and drink choices that will promote students growth and development, learning, and healthy life-long eating habits. As part of the effort to improve childrens health in Massachusetts, the State Legislature asked the Massachusetts Departments of Public Health and Elementary and Secondary Education to develop nutrition standards for our public schools. We would like to tell you about how these standards will be applied in your childs school beginning in August, 2012. The nutrition standards support our goals for student health and academic achievement by concentrating on serving nutrient-rich, minimally processed foods, such as fruits, vegetables, whole grains, lean protein and low-fat dairy products. The new standards were developed by health and education experts using the Institute of Medicines Nutrition Standards for Food in School and the Dietary Guidelines for Americans, 2010 and are focused on what are called competitive foods and drinks sold or provided in public schools during the school day. The standards do not apply to school meals programs, which follow USDA national guidelines. Competitive foods and drinks are those provided in: School cafeteria la carte items (sold separately from school meals) School stores, snack bars, vending machines and concession stands School booster sales, fund-raising activities and other school-sponsored or school-related events School buildings and any other location on school property, including classrooms and hallways
The standards apply to items sold or provided from 30 minutes before the beginning of the school day until 30 minutes after the school day ends. However, foods and drinks sold in vending machines must meet the standards at all times. Attached please find an at-a-glance summary of the standards. We invite you to join us in working with other parents, teachers, nutrition services, school staff and the community through our [insert name of School Wellness Advisory Committee] to put the new standards in place in our schools. We welcome your ideas and support in creating a healthier school environment for our students. Some of the activities you might consider becoming involved in include [insert school wellness activities] Please feel free to call us at [insert phone number] with any questions and ideas you may have. More information about childrens wellness and nutrition is available at www.mass.gov/massinmotion.
Category
Standards
Standards
Foods should have 10% or less of their total calories from saturated fat.
Juice
Milk*
Sugar
Flavored milk with no more than 22 grams total sugar per 8 ounces.
Water
Sodium
Any beverages with added sugar or sweeteners not already addressed will be phased out by August 1, 2013. Flavored milk or milk substitutes that have the same amount or less sugar than plain, fat-free or low-fat milk are allowed. Caffeine
Only juice, milk, milk substitutes and water should be sold or provided.
Calories
la carte entres should not exceed the calorie count of entre items of the equivalent portion size offered as a part of the National School Lunch Program. *(Including alternative milk beverages such as lactose-free and soy)
Fat
Foods should have 35% or less of their total calories from fat.
12/2011
0%
W
PC